Over the course of the 20th century American medicine and public health have witnessed significant advances and achievements in managing illness and improving quality of life for most Americans. Despite these advances, African Americans continue to experience higher mortality rates and an excess burden of illness as compared to their non-minority counterparts. While many factors are believed to create health inequities, a linkage appears to exist between the historic experience of systemic inequality and poor patient outcomes. To date, the relationship between forms of historic inequality and illness in African Americans has been understudied and poorly understood leaving unanswered several critical questions: 1) Did African Americans experience increased illness because they were innately different or because they were kept socially unequal and 2) If African Americans were historically prohibited from receiving care through traditional institutions such as hospitals how did local grass roots organizations mobilize and engage in strategies to meet the health challenges of their communities? Using social historical methodology, this research seeks to answer these questions by exploring the way social, cultural and political influences impacted mortality rates of African Americans infected with Tuberculosis in Philadelphia, 1900-1935. This study will also examine the response of the local African American community, specifically the local church to the health crisis of its congregants. The results of this study will help broaden our understanding of the role of community institutions. This understanding will assist in creating a foundation upon which partnerships between local organizations and researchers involved in health disparities research may be established. Health disparities among African Americans result in poorer health outcomes, excess mortality, and poorer quality of life. Partnerships with community institutions such as the local church are critical to health disparities researchers interested in translating research findings into practice. The innovation in this research is the emphasis on providing foundational knowledge on how health disparities emerge, the way in which health activism develops, and the means through which communities coordinate health services for their residents. Efforts to impact the public's health must begin at the local level, the results of this research offer scholars an opportunity to understand the rich legacy of activism in the local African American community thereby, moving beyond despair to empowerment. [unreadable] [unreadable] [unreadable]